THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.

Uses and
Disclosures:

Health
Services uses health information about you for treatment, to obtain payment
for treatment, for administrative purposes, and to evaluate the quality of
care that you receive. Continuity of care is part of treatment and your
records may be shared with other providers to whom you were referred.
Information may be shared by paper mail, electronic mail, fax, or other
methods. We will only use or disclose identifiable health information
without your authorization as required or permitted by law, otherwise we
will ask for your written authorization before using or disclosing any
identifiable health information about you. : The following are examples of
the types of uses and disclosures of your protected health care information
that Health Services is permitted to make. These examples are not meant to
be exhaustive, but to describe the types of uses and disclosures.

·Treatment: We will use and disclose your protected health
information to provide, coordinate, or manage your health care and any
related services. For example, your relevant protected health information
may be provided to a doctor to whom you have been referred to ensure that
the doctor has the necessary information to diagnose or treat you.

·Payment: Your protected health information will be used, as
needed, in activities related to obtaining payment for your health care
services. For example: For example: your protected health information may
be provided to the college health insurance company to obtain approval for
payment of your claims.

·Business Associates: We will share your protected health
information with third party ‘business associates’ that perform various
activities, For example: Medical Injury/Accident Reports. Whenever an
arrangement between a business associate and us involves the use or
disclosure of your protected health information, we will have a written
contract that contains terms that will protect the privacy of your protected
health information.

·Healthcare Operations: We may use or disclose, as needed, your
protected health information in order to support our business activities.
For example: when we perform peer and chart review, we may need to look at
what an employee has documented in your medical record.

Your
Rights:

In most
cases, you have the right to inspect or obtain a copy of your health
information. If you request copies, we will charge you only the normal
photocopy fees. You also have the right to receive a list of certain types
of disclosures of your information that we made. If you believe that the
health information in your record is incorrect, you have the right to
request that we correct it.

You have
the right to:

·Inspect and copy your protected health information for a civil or
criminal proceeding.

·Request a restriction of your protected health information: You
may ask us not to use or disclose certain parts of your protected
information for treatment, payment or healthcare operations. You may also
request that information not be disclosed to family members or friends who
may be involved in your care. Your request must state the specific
restriction to apply. We are not required to agree to a restriction that
you may request, but if we do agree, then we must behave accordingly.

·Request to receive confidential communication from us by
alternative means or at an alternative location: We will accommodate
reasonable requests. We may also condition this accommodation by asking you
for information as to how payment will be handled or specification of an
alternative address or other method of contact. We will not request an
explanation from you as to the basis for the request.

·Ask your provider to amend your protected health information:
You may request an amendment of protected health information about you. If
we deny your request for amendment, you have the right to file a statement
of disagreement with us, and your medical record will note the disputed
information.

·Receive an accounting of certain disclosures we may have made:
This right applies to disclosures for purposes other than treatment,
payment, or healthcare operations. It excludes disclosures we may have made
to you, for a facility directory, to family members or friends involved in
your care, or for notification purposes. You have the right to receive
specific information regarding these disclosures. The right to receive this
information is subject to certain exceptions, restrictions and limitations.

·Obtain a paper copy of this notice from us: Upon request, even
if you have agreed to accept this notice electronically.

Provider
Responsibilities:

Health
Services is required by law to protect the privacy of your health
information, provide this notice about our information practices, follow the
information practices that are described in this notice, and seek your
acknowledgement of receipt of this notice.

Notice
Revisions:

Before
significant changes are made in our privacy policies, we will make the
revised notice available within sixty (60) days. You can also request a copy
of our notice at any time.

Complaints:

If you
believe that your privacy rights have been violated, you may submit a
complaint to the U.S. Department of Health and Human Services using the
HIPAA Complaint Submission Form at <cms.hhs.gov/hipaa/hipaa2/default.asp> OR
by mail to:

HIPAA
Complaint

7500
Security Blvd,

C5-24-04,

Baltimore, MD 21244

You may also submit a complaint to:

Palomar
College Health Services

1140 W. Mission Road

San Marcos,
Ca. 92069

(760) 744 – 1150 ext 2380

Written
Authorization:

Other uses
and disclosures of your protected information will be made only with your
written authorization, unless otherwise permitted or required by law as
described below. You may revoke this authorization, at any time, in
writing.

Opportunity
to object:

We may use
and disclose your protected health information in the following instances.
You have the opportunity to object. If you are not present or able to
object, then your provider may, using professional judgment, determine
whether the disclosure is in your best interest.

·Others Involved in Your Healthcare: Unless you object, we may
disclose to a member of your family, a close friend or any other person you
identify, your protected health information that directly relates to that
person’s involvement in your health care.

·Emergencies: In an emergency treatment situation, your provider
shall try to provide you a Notice of Privacy Practices as soon as reasonably
practical after the delivery of treatment.

·Communication Barriers: We may use and disclose your protected
health information if your provider attempts to obtain acknowledgement from
you of the Notice of Privacy Practices but is unable to do so due to
substantial communication barriers and the provider determines, using
professional judgment, that you would agree.

Without
Opportunity to Object:

We may use
or disclose your protected health information in the following situations
without your authorization or opportunity to object:

·Public Health: For public health purposes to a public health
authority or to a person who is at risk of contracting or spreading disease.

·Health Oversight: To a health oversight agency for activities
authorized by law, such as audits, investigations, and inspections.

·Abuse or Neglect: To an appropriate authority to report child
abuse or neglect, if we believe that you have been a victim of abuse,
neglect, or domestic violence.

·Food and Drug Administration: As required by the Food and Drug
Administration to track products.

·Legal Proceedings: In the course of legal proceedings.

·Law Enforcement: For law enforcement purposes, such as
pertaining to victims of a crime or to prevent a crime.

·Coroners, Funeral Directors, and Organ Donation: For the
coroner, medical examiner, or funeral director to perform duties authorized
by law and for organ donation purposes.

·Research: To researchers when their research has been approved
by an Institutional Review Board.

·Soldiers, Inmates, and national Security: To military
supervisors of Armed Forces personnel or to custodians of inmates, as
necessary. Preserving national security may also necessitate sharing
protected health information.

·Workers’ Compensation: To comply with workers’ compensation
laws.

·Compliance: To the department of Health and Human Services to
investigate our compliance. In general, we may use or disclose your
protected health information as required by law and limited to the reluctant
requirements of the law.